HIV and Islam: is HIV prevalence lower among Muslims?
Introduction
Behaving in accordance with religious tenets may have impacts on health and disease transmission (Ellison & Levin, 1998; Reynolds & Tanner, 1995). In the context of sexually transmitted diseases (STDs), religiosity and religious affiliation may be negatively related to STDs because of the common constraints religions place on sexuality (Seidman, Mosher, & Aral, 1992). Religious practices such as circumcision can also affect transmission rates of STDs. If religious factors associated with HIV—which is largely transmitted sexually—can be identified, then this endeavour can be important in helping to understand and predict the course of the raging HIV epidemic (Gayle & Hill, 2001; Piot, Bartos, Ghys, Walker, & Schwartlander, 2001).
Following this logic, this paper examines the relationship between HIV and Islam. That is, it tests the hypothesis that Islamic religious affiliation negatively associates with HIV seropositivity. Though this hypothesis has been proposed before (Lenton, 1997; Ridanovic, 1997), no one, to my knowledge, has tested it.
For several reasons, adherence to Islamic tenets may confer protective benefits against the sexual transmission of HIV. While Islamic marital codes permit men to marry as many as four wives and divorce relatively easily, potentially increasing the number of lifetime sexual partners—a known risk factor for acquiring HIV (Stanberrry & Bernstein, 2000; Wasserheit, Aral, Holmes, & Hitchcock, 1991), prohibitions against sex outside of marriage may outweigh these risks. If followed, codes against sex outside marriage for both males and females could reduce premarital and extramarital sex as well as reduce sexual activity with commercial sex workers. Prohibitions against homosexual sex could reduce the risks of, for example, unprotected anal sex.
Islam also prohibits the consumption of alcohol. By increasing risky sexual behaviour, including reduced use of condoms (Bastani et al., 1996; Wilson, Lavelle, Mwoboto, & Armstrong, 1992), alcohol consumption may favour higher rates of sexually transmitted HIV. Islamic attention to ritual washing could increase penile hygiene, lessening the risk of STD transmission (see Lerman & Liao, 2001). Lastly, circumcision has been identified as a practice apparently decreasing HIV transmission (Bailey, Plummer, & Moses, 2001; Weiss, Quigley, & Hayes, 2000). Because all Muslims should be circumcised, this practice may also reduce the acquisition of HIV. For these reasons, we may expect Islamic religious affiliation to be negatively associated with HIV. If adherence to tenets constraining sexuality distinguishes Muslims from members of other religious groups, or Islamic practices systematically differ from those of other religions (e.g., circumcision), then we may also find that there is a stronger, inverse relationship between HIV and Islam compared with HIV and other religions.
Section snippets
Methods
Two methods of data collection were utilised. First, a multivariate analysis was conducted which used information obtained from several large on-line demographic and AIDS databases. All 38 sub-Saharan African countries with a minimum of 1 million inhabitants were included in this analysis. Initially, countries from North Africa, Asia, and the Pacific were also included in this endeavour, but sub-Saharan Africa emerged as the only region for which sufficient national variation in HIV prevalence
Results
The relationship between national HIV prevalence and percentage Muslims within sub-Saharan African countries is shown in Fig. 1. Across sub-Saharan Africa, the multivariate regression model was significant (F=10.60, df=24, p<0.00005) and accounted for a high proportion of the variance in national HIV prevalence rates (R2=0.69). Of the five predictor variables, only percentage Muslims (β=−0.516, p=0.0005) and annual per capita purchasing power (β=0.636, p=0.0002) were significant (population
Discussion
In a sample of sub-Saharan African countries, the percentage of Muslims within countries negatively predicted national HIV prevalence. These results support the hypothesis that HIV prevalence is lower among Muslims. These results discount alternative explanations based on the timing of HIV exposure (i.e., that HIV-1 appears to have evolved in west-central Africa and HIV-2 in West Africa: Holmes, 2001) or HIV transmission increasing more readily among urban populations since the results remain
Conclusions
The hypothesis that Islamic religious affiliation is negatively associated with HIV seropositivity is generally supported. The percentage of Muslims negatively and significantly predicted the prevalence of HIV among sub-Saharan African countries. Six of seven studies enabling within-population comparisons revealed lower HIV prevalence among Muslims. Examination of HIV risk factors and HIV yielded more mixed results: Islamic religious affiliation sometimes appeared to, but other times not to, be
Acknowledgements
I thank Robert C. Bailey, Frank Marlowe, Martin Muller, Megan O’Connell Gray, John Polk, Richard Sosis, and Richard Wrangham for helpful feedback. For inspiring this research, I thank the men in Lamu, Kenya who I interviewed during a project on marriage, parenting, work, and hormones.
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